Day: January 9, 2023

Children struggling with obesity should be evaluated and treated early and aggressively, including with medications for kids as young as 12 and surgery for those as young as 13, according to new guidelines released Monday.

The long-standing practice of “watchful waiting,” or delaying treatment to see whether children and teens outgrow or overcome obesity on their own, only worsens the problem that affects more than 14.4 million young people in the U.S. Left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.

“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they’ll have [obesity] in adulthood.”

For the first time, the group’s guidance sets ages at which kids and teens should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavior and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio.

In general, doctors should offer adolescents 12 and older who have obesity access to appropriate drugs and teens 13 and older with severe obesity referrals for weight-loss surgery, though situations may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood Weight, and a co-author of the guidelines.

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said.

‘Not a lifestyle problem’

Young people who have a body mass index that meets or exceeds the 95th percentile for kids of the same age and gender are considered obese. Kids who reach or exceed that level by 120% are considered to have severe obesity. BMI is a measure of body size based on a calculation of height and weight.

Obesity affects nearly 20% of kids and teens in the U.S. and about 42% of adults, according to the Centers for Disease Control and Prevention.

The group’s guidance takes into consideration that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It predominately emerges from biological factors.”

The guidelines come as new drug treatments for obesity in kids have emerged, including approval late last month of Wegovy, a weekly injection, for use in children ages 12 and older. Different doses of the drug, called semaglutide, are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, made by Novo Nordisk, helped teens reduce their BMI by about 16% on average, better than the results in adults.

How Wegovy works

The drug affects how the pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.

“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to get because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about enhanced weight loss.

In addition, many insurers won’t pay for the medication, which costs about $1,300 a month.

One expert in pediatric obesity cautioned that while kids with obesity must be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.

“It’s not that I’m against the medications,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I’m against the willy-nilly use of those medications without addressing the cause of the problem.”

Lustig said children must be evaluated individually to understand all factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, particularly ultra-processed foods high in sugar and low in fiber.

Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she’d like more research about the drug’s efficacy in a more diverse group of children and about potential long-term effects before she begins prescribing it regularly.

“I would want to see it be used on a little more consistent basis,” she said. “And I would have to have that patient come in pretty frequently to be monitored.”

At the same time, she welcomed the group’s new emphasis on prompt, intensive treatment for obesity in kids.

“I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this — maybe the majority,” she said.
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A modified jumbo jet carrying a Virgin Orbit rocket took off from southwestern England Monday, marking the first attempt to launch satellites into orbit from Western Europe.

Hundreds gathered for the launch cheered as the repurposed Virgin Atlantic Boeing 747 aircraft, named “Cosmic Girl,” took off from Cornwall late Monday. Around an hour into the flight, the plane will release the rocket at 35,000 feet (around 10,000 meters) over the Atlantic Ocean to the south of Ireland.

The rocket will then take nine small satellites for mixed civil and defense use into orbit, while the plane, piloted by a Royal Air Force pilot, returns to Cornwall.

If successful, the mission will mark the first international launch for Virgin Orbit, founded by British billionaire Richard Branson. The company, which is listed on the NASDAQ stock exchange, has already completed four similar launches from California.

In the past, satellites produced in the U.K. had to be sent to spaceports in other countries to make their journey into space.

Some of the satellites are meant for U.K. defense monitoring, while others are for businesses such as those working in navigational technology. One Welsh company is looking to manufacture materials such as electronic components in space.

“This is the start of a new era for the U.K. in terms of launch capabilities,” said Ian Annett, deputy chief executive at the U.K. Space Agency. There was strong market demand for small satellite launches, he said, and the U.K. has ambitions to be “the hub of European launches.”

Annett said it was too early to say whether more missions are planned in coming months.

The mission is a collaboration between the U.K. Space Agency, the Royal Air Force, Virgin Orbit and Cornwall Council.

The launch was originally planned for late last year, but it was postponed because of technical and regulatory issues.
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One year after Australia deported Serbian tennis champion Novak Djokovic for refusing to get vaccinated, Australian Open tournament officials say players this year will not be tested for COVID-19 and would even be allowed to compete even if they had the virus. 

Tournament director Craig Tiley told reporters Monday they are telling players and tournament staff to stay away if they feel ill, but otherwise they will not be tested. If they have already been tested, they will not be required to disclose their status. 

Tiley said the tournament just wanted to “follow what is currently in the community.” 

The new policy is a stark change from the strict protocols of the past two years, when spectators were banned from the tournament, matches were played in a bio-secure “bubble,” and nine-time tournament champion Djokovic was not allowed to play. 

Last week, during a Cricket match in Sydney between South Africa and Australia, Australian Cricketer Matt Renshaw was allowed to play in a five-day test match despite testing positive for COVID. 

Riley said, “It’s a normalized environment for us and, not dissimilar to cricket, there will potentially be players that will compete with COVID.” 

The more relaxed rules for sports reflects Australia’s more relaxed rules regarding COVID-19. At the height of the pandemic, the nation — and Melbourne in particular -— endured some of the longest and strictest lockdowns.   

But in the past year, mandates regarding safeguards such as testing, and mask-wearing have been replaced. 

Some information for this report was provided by The Associated Press and Reuters. 
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China will not include Pfizer Inc’s Paxlovid in an update to its list of medicines covered by basic medical insurance schemes as the U.S. firm quoted a high price for the COVID-19 drug, China’s Healthcare Security Administration (NHSA) said Sunday.   

The COVID-19 antiviral drug is currently covered by the country’s broad health care insurance scheme under temporary measures the regulator introduced in March last year as outbreaks rose.   

But authorities held talks with Pfizer in recent days to decide whether to include it in the latest version of their list, which they update annually.   

Inclusion on the list means a drug is accessible via state insurance schemes, which will boost volumes but comes with the condition that manufacturers lower prices. Past rounds have seen drugmakers cut prices by as much as 62% after negotiations with officials.   

“We will continue to collaborate with the Chinese government and all relevant stakeholders to secure an adequate supply of Paxlovid in China. We remain committed to fulfilling the COVID-19 treatment needs of Chinese patients,” Pfizer said in a statement, without elaborating.   

The NHSA said Paxlovid would continue to be eligible to be paid for by state medical insurance until the current planned end-date to the temporary measures of March 31.   

While the talks on Paxlovid failed, they succeeded with two other COVID-19 treatment drugs — herbal medication Qingfei Paidu granules and Chinese drugmaker Genuine Biotech’s Azvudine — which will be included in the list’s update, the regulator said.   

Three years into the pandemic, China began pivoting away from its signature “zero COVID” policy last month after historic protests of the economically-damaging curbs that had been championed by President Xi Jinping.   

The sudden loosening of restrictions has fueled a giant wave of infections and prompted many to turn to underground channels to procure remedies such as Paxlovid, which a clinical trial has found to have reduced hospitalizations in high-risk patients by around 90%.   

Boxes of Paxlovid are changing hands for as much as 50,000 yuan ($7,313.15), more than 20 times the original price of 2,300 yuan, according to local media reports and social media posts.   

Beijing has been largely resistant to Western vaccines but has greenlighted foreign oral treatments Paxlovid and Merck’s Molnupiravir. It approved Paxlovid in February.   

Reuters reported Saturday, citing sources, that China is in talks with Pfizer to secure a license that will allow domestic drugmakers to manufacture and distribute a generic version of Paxlovid.   

Last month, China Meheco Group Co Ltd said Wednesday it signed an agreement with Pfizer to import and distribute Paxlovid in mainland China.   

Pfizer also signed a deal in August for Chinese drugmaker Zhejiang Huahai to produce Paxlovid in mainland China solely for patients there. 
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The public school district in Seattle has filed a novel lawsuit against the tech giants behind TikTok, Instagram, Facebook, YouTube and Snapchat, seeking to hold them accountable for the mental health crisis among youth.

Seattle Public Schools filed the lawsuit Friday in U.S. District Court. The 91-page complaint says the social media companies have created a public nuisance by targeting their products to children.

It blames them for worsening mental health and behavioral disorders including anxiety, depression, disordered eating and cyberbullying; making it more difficult to educate students; and forcing schools to take steps such as hiring additional mental health professionals, developing lesson plans about the effects of social media and providing additional training to teachers.

“Defendants have successfully exploited the vulnerable brains of youth, hooking tens of millions of students across the country into positive feedback loops of excessive use and abuse of Defendants’ social media platforms,” the complaint said. “Worse, the content Defendants curate and direct to youth is too often harmful and exploitive ….”

While federal law — Section 230 of the Communications Decency Act — helps protect online companies from liability arising from what third-party users post on their platforms, the lawsuit argues that provision does not protect the tech giants’ behavior in this case.

“Plaintiff is not alleging Defendants are liable for what third-parties have said on Defendants’ platforms but, rather, for Defendants’ own conduct,” the lawsuit said. “Defendants affirmatively recommend and promote harmful content to youth, such as pro-anorexia and eating disorder content.”

In emailed statements Sunday, Google and Snap said they had worked to protect young people who use their platforms.

Snap launched an in-app support system called ‘Here For You’ in 2020, to help those who might be having a mental health or emotional crisis find expert resources, and it also has enabled settings that allow parents to see whom their children contact on Snapchat, though not the content of those messages. It also has recently expanded content about the new 988 suicide and crisis phone system in the U.S.

“We will continue working to make sure our platform is safe and to give Snapchatters dealing with mental health issues resources to help them deal with the challenges facing young people today,” the company said in a written statement.

José Castañeda, a spokesperson for Google, said Google, which owns YouTube, had also given parents the ability to set reminders, limit screen time and block certain types of content on their children’s devices.

“We have invested heavily in creating safe experiences for children across our platforms and have introduced strong protections and dedicated features to prioritize their well-being,” Castañeda said.

Meta and TikTok did not immediately respond to requests for comment.

The lawsuit says that from 2009 to 2019, there was on average a 30% increase in the number of Seattle Public Schools students who reported feeling “so sad or hopeless almost every day for two weeks or more in a row” that they stopped doing some typical activities.

The school district is asking the court to order the companies to stop creating a public nuisance, to award damages, and to pay for prevention education and treatment for excessive and problematic use of social media.

While hundreds of families are pursuing lawsuits against the companies over the harm they allege their children suffered from social media, it’s not clear if any other school districts have filed a complaint like Seattle’s.

Internal studies revealed by Facebook whistleblower Frances Haugen in 2021 showed that the company knew that Instagram negatively affected teenagers by harming their body image and making eating disorders and thoughts of suicide worse. She alleged that the platform prioritized profits over safety and hid its own research from investors and the public.
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